Blueprint for empowerment

The adage “our past does not dictate our future” was a guiding principle for the Livingston County Board of Supervisors and Director of Long Term Care Franklin N. Bassett as they rolled up their sleeves and collaborated with a local design team to build a progressive new nursing and rehabilitation center where the only thing reminiscent of any of this county's previous facilities was the rooftop cupola. “In a dramatic departure from our old floor plans,” Bassett says, “we let our vision for our residents’ quality of life drive the design. Add our philosophy of empowering residents in decision making, respect for their individuality, and a strong emphasis on maintaining social connectedness for both residents and staff, and the outcome has been that many residents feel their life has a renewed sense of purpose within ‘living neighborhoods’ as functionally diverse as the towns and villages of our county.”

Architecturally, form follows function to complement lifestyle, where the facility design employs a cluster concept that includes many unique spaces on each floor to provide the social equivalent of “streets, neighborhoods, and households.” Each 48-resident “neighborhood” is divided into two 24-resident “households,” and further divided into two 12-member “family units.” Nurses’ stations are not found here, but instead just a friendly medical typist station/greeter desk at the entry of each neighborhood. All other staff and core facilities for the households are accessed from the “main streets” bisecting each neighborhood rather than from within the family units. In fact, the only staff accommodations within the family units are nursing substations resembling writing desks, medical and isolation supply closets, and clean linen, all within 14 feet of any resident room. Visitors to each family unit are greeted by a “front porch” area, then welcomed into a living room with a hearth and entertainment center, and are delighted to find wide circulation areas, in lieu of corridors, with social space—alcoves adjacent to most bedrooms. Shared dining rooms between each pair of family units include a residential-scaled preparation, heat, and hold kitchen from which all meals for each group of 24 residents are served family style.

“The fear of losing control quickly fades away for new residents as they learn that their preferences in food, waking, bedtime, and bathing will be respected to help maintain their familiar life rhythm in their daily experience here,” says Bassett. “Admittedly, this undertaking challenges task-oriented approaches to institutional care and demands a greater understanding of the resident as a person. Collectively, residents are represented on neighborhood Resident Councils and are liaisons to neighborhood (Staff) Team meetings, resulting in each neighborhood having the autonomy to adjust its work processes and lifestyle.” An example of this newfound empowerment is the grassroots movement begun by residents to increase the $50 monthly Personal Needs Allowance that Medicaid recipients in New York State have received for the past 20 years. “The administration here has supported us in petitioning our county board to pass a resolution in support of our issue, which was sent to our legislators. We have used the computers here to e-mail nearly every nursing home in the state to help with letter writing to our elected officials in Albany,” explains Beverly, Resident Council president and movement leader.

With such a successful model in design and operation, residents of Livingston County, New York, can age gracefully and be assured they will maintain a familiar rhythm of life while staying at the center.